1. Can you please explain what "psuedotumor cerebri sine papilledema" is?
2. I hear about using molecular information for classifying and treating brain tumors. What does this mean?
3. Is it normal to experience fatigue following brain tumor treatment?
4. Could you explain to me what the "silent area" means and how symptoms from a brain tumor can affect the functions of the frontal lobe?
5. Does hormone replacement therapy contribute to the recurrence of brain tumors?
6. Since the surgery I look like the same person, but I have some limitations that are not easily recognized from people who know me. My friends keep asking me if I'm "normal". I feel like I'm disappointing them if I tell them I have some limitations. What should I do?
7. I have had nerve pain in my face since surgery. What can I do about this pain?
8. My husband has a brain tumor and since he started his chemotherapy he has been extremely tired. What can I do to help him? 

NOTE: The general medical information provided in this column is not a substitute for your doctor's medical advice. Consult your physician about your individual medical treatment before making any decisions regarding your health care.

 
Can you please explain what "psuedotumor cerebri sine papilledema" is?

Psuedotumor cerebri is also known as benign intracranial hypertension. This syndrome is seen most often in obese adolescent girls and young women. But less commonly, it does occur in men. The chief complaint is headaches, and in some instances, people experience diplopia (double or blurred vision), slight numbness of the face, or dizziness. On physical examination, the person seems quite well. The only abnormal finding is papilledema (swelling or protrusion of the blind spot of the eye caused by edema), which you may not have. Cerebrospinal fluid (CSF) pressure may be high and a CT scan or MRI may show ventricles of normal size. The goal of treatment is to relieve the increased pressure in the head. Treatment options include repeated lumbar punctures to remove the CSF until normal pressure is maintained. Drug therapy is controversial. However, three drugs (Prednisone, Glycerol and Diamox) are treatment options if CSF pressure continues to be elevated and papilledema persists. In persons who do not respond to any of the above treatments - placement of a lumbar shunt may be needed. You are not alone in this diagnosis. People do suffer with this disease because of the health problems associated with the obesity and the headaches.

 
I hear about using molecular information for classifying and treating brain tumors. What does this mean?

Traditionally, the methods used in the classification and grading of tumors have been to examine the tissue under a microscope and identify characteristics of a specific central nervous system cell type. Grading is based on the level of abnormality such as shape and rate of cell division (i.e. how fast the tumor is growing). This system is useful for predicting overall survival of people with specific types of brain tumors, and historically has been used to help determine the type of treatment to use.

However, it does not provide insight into the molecular makeup of the tumor, and tissue samples that look identical under a microscope might differ significantly in their clinical course. Recently, scientists have begun focusing on differences at the molecular level, even in seemingly similar cell types and grades. Some of these molecular differences have been linked to better prognosis and heightened responsiveness to particular treatments. This has caused a greater interest in testing for some of these specific molecular characteristics. One example is that patients with anaplastic oligodendroglioma who have 1p and 19q chromosomal deletions may respond differently to treatment. Examining a tumor for the chromosomal makeup is now available, though it does require tumor tissue.

Glioblastoma is molecularly diverse with several possible oncogene or tumor suppression gene alterations, and varying patterns of chromosomal gain or loss. This leads to discrepancies in patient survival and may require different treatments. Extensive molecular data is slowly becoming more available that will help separate the molecular subsets within a glioblastoma diagnosis. We are at the beginning. Even though tests may not yet change current treatments, they increase understanding of tumor tissue and may help in future research and the development of targeted therapies.

 
Is it normal to experience fatigue following brain tumor treatment?

Yes, it is normal to experience fatigue following brain tumor treatment. Brain tumor treatment fatigue is a feeling of tiredness, often more severe than tiredness normally felt from a lack of a good night's sleep. Individuals have described brain tumor fatigue as weakness, exhaustion, lack of energy, sleepiness, drowsiness, confusion, and impatience. Most people have a lack of "pep," and feel a strong desire to stop, rest, and even lie down and sleep. When people experience cancer fatigue, it may affect the way they think. They may have trouble paying attention, reading, watching television, or talking with family members. They may find they may not be able to do all the activities that they used to do. The cause of brain tumor fatigue is not known; however, there are several ways to manage brain tumor treatment fatigue:

• Plan your day so that you have time to rest.
• Take short naps or breaks, rather than one long rest period.
• Eat as well as you can and drink plenty of fluids.
• Take short walks or do light exercise if possible.
• Try easier or shorter versions of activities you enjoy.
• Try activities that are less strenuous, like listening to music or reading.
• Save your energy for the most important things.
• Become comfortable asking others to help with things that you used to be able to do alone.
• Develop consistent sleep habits (go to bed and get up at the same time every day).

If you continue to have problems with brain tumor treatment fatigue, consult your physician or oncology nurse. 

 
Could you explain to me what the "silent area" means and how symptoms from a brain tumor can affect the functions of the frontal lobe?

The right frontal lobe has been considered a "silent area" of the brain because often times people with small tumors in this area do not have any noticeable changes or symptoms. However, if the tumor is large or begins to grow or swelling causing increased intracranial pressure, then symptoms occur. The functions of the frontal lobe include storage of memory, and "executive" functions such as concentration, abstraction in thought, and ability for self-control. There are many connections from the frontal lobe to the other parts of the brain that control vision and automatic functions such as respiration, gastrointestinal activity, and blood pressure. In addition, the posterior or back part of the frontal lobe controls motor function. Formulation of words in the speech process is found in our dominant frontal lobe. Depending on the size and location of the tumor in the frontal lobe, patients may have a collection of symptoms known as "frontal lobe syndrome". These symptoms include behaviors such as inattentiveness, inability to concentrate, emotional instability, indifference, loss of self-restraint, inappropriate social behavior, inability to retain new information, difficulty with abstract thought, as well as the appearance of a quiet or flat persona. A patient may also experience headaches or seizures. If a patient is starting to develop more symptoms or the symptoms have changed, the doctor needs to be called for consideration of further treatment because of possible tumor recurrence and/or swelling. A neuropsychologist should also be contacted for further evaluation and coping measures.

 
Does hormone replacement therapy contribute to the recurrence of brain tumors?

Hormone replacement therapy (HRT) is the provision of estrogen for women whose natural estrogen decreases during the time of menopause. Female brain tumor patients diagnosed with meningiomas have been concerned about HRT because estrogen has been found in meningiomas. Some patients fear that hormone replacement with estrogen may cause the tumor to recur. Presently, there have been no scientific data on HRT response, the choice to engage or remain on HRT is a point of discussion for each person and one's physician.

 
Since the surgery I look like the same person, but I have some limitations that are not easily recognized from people who know me. My friends keep asking me if I'm "normal". I feel like I'm disappointing them if I tell them I have some limitations. What should I do?

The symptoms that you are experiencing since surgery are not uncommon. Following brain surgery, many people suffer from short term memory loss, an inability to fully concentrate, and fatigue. It sounds like you understand your limitations and are dealing with them. Many people around you want to believe that everything is back to exactly how things were before the surgery. What was "normal" for you in the past may not be the same now. I suggest that you do not go into detail about the changes that have taken place because it is often hard for people to understand. You may want to explain to them that some things have changed. You may be a little forgetful, and tired, but that you are doing fine. Your friends will know that you are managing and that you are able to cope with your disease. They will feel less guilty about not getting you fully back to "normal".

 
I have had nerve pain in my face since surgery. What can I do about this pain?

Nerve pain is not terribly common after surgery, but when it occurs it can be very annoying and difficult to relieve. Most physicians will try anticonvulsant medications such as Dilantin or Tegretol to relieve the pain. If the pain continues, there are other means to relieve the pain, such as surgery. However, the best solution is to go to a pain clinic. Most large medical settings have pain clinics to help patients with intractable pain. Pain clinics work with surgeons, anesthesiologists and psychologists. They provide a comprehensive approach on how to relieve or manage post-operative nerve pain.

 
My husband has a brain tumor and since he started his chemotherapy he has been extremely tired. What can I do to help him?

Ask your doctor to take a red blood cell count to evaluate the causes of fatigue. Fatigue is commonly overlooked side effect for both radiation and chemotherapy. One reason that chemotherapy causes fatigue is because the red blood cell count is low. The red blood cells deliver oxygen to different parts of the body. When they are low or not plentiful, the body is deprived of oxygen. This can result in a condition called anemia, which is the culprit in fatigue. The good news is that anemia can be treated with medications.

There are several ways to cope with cancer related fatigue, and here are some suggestions:

1. Prioritize your activities. Reserve your energy to get the things done that are most important to you.
2. Keep a journal of how you are feeling. It doesn't have to be elaborate, but note your fatigue level at different times of the day. This can help you determine how best to plan your activities according to your energy level.
3. Avoid taking long naps. Take a limited nap during the day, because you want to promote a good nights sleep. Light exercise, such as walking, often decreases fatigue.
4. Don't be afraid to ask for help! If you need help finishing a task, ask for it. This allows you to accomplish things you enjoy and still have time to rest.
5. Utilize the wisdom of other cancer patients. Joining a support group is an excellent way to learn from the experiences of other patients who are coping with cancer related fatigue.
6. Make sure you are getting enough food and water. Cancer treatments can cause appetite loss. Getting enough calories and nutrients helps alleviate fatigue.

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